Desert Canyon Post Acute, LLC

In the surveyor’s words

From the most serious findings on record at Desert Canyon Post Acute, LLC, in the surveyor’s own words.

• Actual harm, isolatedF600Aug 1, 2024

  Based on interview and record review, the facility failed to protect the resident's right to be free from physical abuse (the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish .includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology) by another resident for one of ten sampled residents (Resident 1). On 7/17/2024 at 5:15 a.m., Resident 2 poured lemon juice on Resident 1's face while Resident 1 was sleeping. […]

• Actual harm, isolatedF689Aug 1, 2024

  Based on interview and record review, the facility failed to ensure residents receive the necessary care based on the assessed individual needs to prevent accidents and minimize injuries forone of ten sampled residents (Resident 3), who was identified as a high fall risk. The facility failed to: 1. Ensure Resident 3 was provided visual supervision while sitting on a Geri-chair (a padded reclining chair that was designed to help older adults with limited mobility) in the hallway. 2. Review and revise Resident 3's care plan interventions that were person-centered and were individualized based on the resident's risks, physical, and mental condition. 3. […]

• Actual harm, isolatedF658Apr 11, 2023

  Based on interview and record review, the facility failed to provide nursing services that meet professional standards of practice for one of two sampled resident (Resident 1). On 3/1/2023, at 11 a.m., when Certified Nursing Assistants 1 and 2 (CNAs 1 and 2) informed Licensed Vocational Nurse 1 (LVN 1) Resident 1 slipped out of the lift machine (designed to lift and transfer patients from one place to another and may be operated using a power source or manually) sling (or sling lift, consists of a soft fabric tool that wrap around a patient's body and it is hooked to the lift machine; sling lifts come in various sizes, materials, and weight capacities). CNAs 1 and CNA 2 reported CNA 2 was able to catch Resident 1 before hitting the floor. LVN 1 failed to: 1. […]

• Actual harm, isolatedF689Apr 11, 2023

  Based on observation, interview, and record review, the facility failed to ensure its residents were free from accident hazards for one of two sampled residents (Resident 1). On 3/1/2023 at 11 a.m., Certified Nursing Assistant 1 (CNA 1) with CNA 2 were transferring Resident 1 from the shower chair to bed using a lift machine (designed to lift and transfer patients from one place to another and may be operated using a power source or manually; lift machines use a lifting sling [soft fabric tool that wrap around a patient's body] hooked to the lift; sling lifts come in various sizes, materials, and weight capacities). CNA 1 used the wrong size of sling (an extra-large when Resident 1 was small) and Resident 1 slipped down and out of the sling. […]

• Actual harm, isolatedF689Aug 19, 2021

  Based on interview, and record review, the facility failed to ensure that one of three sampled residents (Resident 1), who was assessed at risk for falls (move downward, typically rapidly and freely without control, from a higher to a lower level), was kept free from accident and hazards by failing to: 1. Ensure Resident 1 was provided with one to one supervision (one specific person will be assigned to remain at the resident's side to ensure safety) as recommended to prevent 10 unwitnessed falls from 2/6/2021 to 4/9/2021. 2. Develop a resident-centered care plan with interventions and approaches addressing Resident 1's continued episodes of falls. 3. […]